Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Monday,
January 17, 2000, in observance of Martin Luther King Jr.ís Birthday.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Update on Year 2000 Activities

Please refer to the Special Provider Bulletin for Year 2000 issued December
1999. The Special Bulletin consolidates information about Year 2000 activities
and plans as well as instructions and suggestions for providers to move smoothly
into the new century.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

North Carolina Electronic Claims Submission Software (NCECS)

As mentioned in several recent bulletins, Medicaid has replaced the old NECS
software with newer NCECS software. The new software creates files for transmission
over modem as well as on a mail-in diskette. The NECS software was DOS based;
the NCECS runs in Windows 95, Windows 98 or Windows NT 4.0, which are classified
as 32 bit operating systems. NCECS will not operate in a Windows 3.1 environment
since it is not a year 2000 compliant system.

Based upon problems discovered internally, EDS has improved and corrected the
NCECS product in several areas. This includes the following improvements:

Providers will be able to print copies of the prepared claims

Problems with the listing of recurring values has been corrected (i.e.,
allow multiple same last recipient names in drop down lists)

The software no longer requires the patient status entry in Form Locator
22 of the UB-92 for Personal Care Claims. This change allows providers to
follow the specific billing instructions for their services

Enhancement of the changing dates of service function to allow mass change
of dates of service for multiple recipients Ė this feature is often needed
by the nursing home provider

The modifications are on a diskette that was mailed with instructions to each
NCECS user. Providers who have installed the NCECS software from the CD-ROM
need to be sure that they have also installed the modifications from the update
diskette. Providers who have not received the diskette should contactthe ECS Unit, EDS, at 1-800-688-6696 or 919-851-8888.

Minimal PC requirements for the use of NCECS include:

Pentium series recommended; 486 machines will function

Minimum of 32 megabytes of memory

Minimum 20 megabytes of hard drive storage

A browser such as Microsoft Internet Explorer (version 3.0 or higher) or
Netscape (version 3.0 or higher)

Providers must supply the browser. These are on a release diskette as part
of the Windows 95, 98 and NT Software, or may be downloaded and installed from
one of the following addresses:

The Microsoft version is found at http://www.microsoft.com/catalog.

The Netscape version is available at http://home.netscape.com/computing/download/

ECS Unit, EDS, 1-800-688-6696 or 919-851-8888

Attention: Dialysis Providers

Dialysis Termination Dates

Dialysis Providers treating recipients who receive ongoing dialysis treatments
are paid a monthly Composite Rate. The Composite Rate includes services normally
rendered to dialysis recipients such as physician visits, lab tests and medical
supplies. In order to accurately process dialysis claims the provider must submit
a dialysis start date, which is entered into the recipientís dialysis
file. Claims that include services covered in the Composite Rate will deny when
the date of service is after the dialysis start date.

Recipients who have had acute illness involving the renal system, or receive
successful kidney transplants which result in the return of normal renal function,
may no longer require continued dialysis treatments.

It is imperative that providers notify EDS with the STOP date
when dialysis treatments are terminated so the date of the last dialysis treatment
can be entered in our records and future claims can be properly processed.

To notify EDS, providers should send a resolution inquiry form stating "Dialysis
has terminated" including the Dialysis STOP dateMM/DD/YYYY
and the reason for discontinuation of the treatments to the address
in the example given below:

Attention: All Providers

2000 CPT Update

Effective with date of service January 1, 2000, Medicaid providers may bill
the 2000 Current Procedural Terminology (CPT) codes. Claims filed with deleted
1999 CPT codes for dates of service January 1, 2000 through March 31, 2000 will
be accepted for processing. However, the 2000 CPT codes must be used
for dates of service on or after April 1, 2000.

The following new CPT codes require further review by the Division of Medical
Assistance and are currently not covered:

The new 2000 CPT codes that are noncovered by North Carolina Medicaid are:

CPT 58672 Laparoscopy, surgical; with fimbrioplasty

CPT 58673 Laparoscopy, surgical; with salpingostomy

CPT 58679 Unlisted Laparoscopy procedure, oviduct, ovary

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Labs

Reimbursement Rate Increase

New lab rates are effective with date of service January 1, 2000. A 1.4 % increase
has been implemented not to exceed the national Medicare cap. A rate decrease
has been implemented for lab codes in which the current rate exceeded the 2000
national Medicare cap. The actual billed amount on your claims must always
contain your regular billed amount and not the price on the fee schedule unless
the listed price represents what you normally bill another payor or patient.
DMA considers the billed amount in their rate setting efforts. New fee schedules
will be available at the end of January or early February. Please refer to instructions
in the November 1999 bulletin on ordering fee schedules.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Physicians

Reimbursement Rate: Physician Fees

Effective with dates of service January 1, 2000, Physiciansí fees are based
on the Medicare fee schedule resource based relative value system currently
in effect. This change results in paying physician services equal to Medicare
for the same procedure for the same date of service and uses updated (RBRVS)
values.

Medicare has adopted a new relative value method to calculate physician fees
for facility-based services furnished in hospital (inpatient, outpatient and
emergency room), ambulatory surgical center and skilled nursing facility settings.
This method is the facility based fee concept. It identifies two levels of practice
expense RVUs, facility and non-facility, for each procedure code. The non-facility
practice expense RVUs are used for services performed in a physicianís office
and for services to a patient in the patientís home, facility or institution
other than hospital, skilled nursing facility (SNF) or ambulatory surgical
center (ASC). The facility practice expense RVUs are used for services furnished
to hospital, SNF and ASC patients.

The allowable for a specific code is determined by the place of service,
as indicated on the claim, where the procedure is performed. There are numerous
codes that are only performed by definition in a certain setting and
will have only one level of practice expense. The fees for these types
of codes are the same for non-facility and facility regardless of the place
of service indicated on the claim. Modifier pricing is not affected by this
change.

The voice inquiry system has been updated and will allow providers to enter
the place of service in order to provide the appropriate allowable for the code
in question.

New fee schedules will be available at the end of January or early February.
Please refer to instructions in the November 1999 bulletin on ordering fee schedules.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Dentists

Reimbursement Rate Increase

Effective with date of service January 1, 2000, reimbursement rates increase
by 1.4%. The actual billed amount on your claims must always contain
your regular billed amount and not the price on the fee schedule unless the
listed price represents what you normally bill another payor or patient. DMA
considers the billed amount in their rate setting efforts. New fee schedules
will be available at the end of January or early February. Please refer to instructions
in the November 1999 bulletin on ordering fee schedules.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Hospice Providers

Hospice Rates

Effective with date of service January 1, 2000, hospice rates are as follows:

Routine Home Care

Continuous Home Care

Inpatient Respite Care

General Inpatient Care

Hospice Intermediate R & B

Hospice Skilled
R & B

Metropolitan Statistical Area

SC

RC 651
Daily

RC 652
Hourly
(1)

RC 655
Daily
(2) (3) (4)

RC 656
Daily
(3) (4)

RC 658
Daily
(5)

RC 659
Daily
(5)

Asheville

39

95.76

23.29

99.77

426.98

88.92

118.54

Charlotte

41

101.17

24.60

104.17

449.38

88.92

118.54

Fayetteville

42

91.77

22.32

96.51

410.44

88.92

118.54

Greensboro/WS/HP

43

100.16

24.36

103.35

445.21

88.92

118.54

Hickory

44

95.51

23.23

99.56

425.91

88.92

118.54

Jacksonville

45

85.73

20.85

91.59

385.41

88.92

118.54

Raleigh/Durham

46

102.08

24.83

104.91

453.15

88.92

118.54

Wilmington

47

98.68

24.00

102.14

439.06

88.92

118.54

Rural

53

89.76

21.83

94.87

402.10

88.92

118.54

Goldsboro

105

92.79

22.57

97.34

414.66

88.92

118.54

Greenville

106

99.34

24.16

102.68

441.80

88.92

118.54

Norfolk, Currituck Co

107

90.94

22.12

95.84

407.00

88.92

118.54

Rocky Mt.

108

96.29

23.42

100.19

429.15

88.92

118.54

Note: Because providers are expected to bill their usual and customary charges,
no adjustments will be accepted.

Key to Hospice Rate Table:

SC = Specialty Code

RC = Revenue Code

A minimum of eight hours of Continuous Home Care must be provided.

There is a maximum of five consecutive days including the date of admission
but not the date of discharge for Inpatient Respite Care. Bill for the sixth
and any subsequent days at the routine home care rate.

Payments to a Hospice for inpatient care are limited in relation to all
Medicaid payments to the agency for hospice care. During the 12 month period
beginning November 1 of each year and ending October 31, the aggregate number
of inpatient days, inpatient respite, and general inpatient, may not exceed
20 percent of the aggregate total number of days of hospice care provided
during the same time period for all the hospiceís Medicaid patients. Hospice
care provided for patients with acquired immune deficiency syndrome (AIDS)
is excluded in calculating the inpatient care limit. The Hospice refunds any
overpayments to Medicaid.

Date of Discharge: For the day of discharge from an inpatient unit, the
appropriate home care rate should be billed instead of the inpatient care
rate unless the recipient dies as an inpatient. When the recipient is discharged
as deceased, the inpatient rate (general or respite) is billed for the discharge
date.

When a Medicare/Medicaid recipient is in a nursing facility, Medicare
is billed for the routine or continuous home care, as appropriate, and Medicaid
is billed for the appropriate long term care rate. When a Medicaid only
hospice recipient is in a nursing facility, the Hospice may bill for the appropriate
long term care (SNF/ICF) rate in addition to the home care rate provided in
revenue code 651 or 652. See section 8.15.1, page 8-11, of the Medicaid Community
Care Manual for details.

DMA, 919-857-4165

Attention: CAP Providers

Reimbursement Rate Increase: CAP Providers

Effective with date of service January 1, 2000, the maximum allowable rate
for the following CAP services increased. Providers must bill their usual and
customary charges.

Procedure Code

Description

Reimbursement Rate

W8111

CAP-MR/DD Personal Care

$3.18/15" Unit

W8116

CAP/DA Respite Care-In Home

$3.18/15" Unit

W8119

CAP-MR/DD Respite Care Community Based

$3.18/15" Unit

W8141

CAP/DA In-Home Aide Level II

$3.18/15" Unit

W8142

CAP/DA In-Home Aide Level III-Personal Care

$3.18/15" Unit

W8143

CAP/C Personal Care

$3.18/15" Unit

W8144

CAP-MR/DD In-Home Aide Level I

$3.18/15" Unit

W8167

CAP/AIDS Respite Care-In-Home/Aide Level

$3.18/15" Unit

W8172

CAP/AIDS In-Home Aide II

$3.18/15" Unit

W8173

CAP/AIDS In-Home Aide III-Personal Care

$3.18/15" Unit

No adjustments will be made for claims already processed. Contact the EDS Provider
Services Unit for detailed billing instructions.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Personal Care Providers (excluding Adult
Care Homes)

Reimbursement Rate Increase: Personal Care Providers

Effective with date of service January 1, 2000, the Medicaid maximum reimbursement
rate for personal care service is $3.18 per 15-minute unit ($12.72/hour). No
adjustments will be made to previously filed claims.

The providersí customary charges to the general public must be shown in form
locator 47 on each UB-92 claim form filed. Public providers with nominal charges
that are less than 50 percent of cost should report the cost of the service
in form locator 47. The payment of each claim will be based on the lower of
the billed charges or the maximum allowable rate.

Debbie Barnes, Financial OperationsDMA, 919-857-4165

Attention: Home Health Providers, PDN Providers and
Community Alternatives Program Case Managers

Amendments to Home Health Medical Supply List

Based on recommendations of a committee representing the Association for Home
Health and Hospice Care of North Carolina and the Division of Medical Assistance,
the home health medical supply list is amended effective with date of service
January 1, 2000.

HCPCS Code W4645 - I.V. infusion start kit (venipuncture kit) is replaced with
HCPCS Codes W4740 and W4741 to allow providers to bill for the kits separately.
Effective with date of service January 1, 2000, claims for W4645 will not be
paid.

The following items are added to the supply list and may be billed effective
with date of service January 1, 2000:

HCPCSCode

Description

BillingUnit

MaximumRate

W4742

Cotton-tip applicators (sterile)

Each

.10

W4738

Catheter (Coudeí-type)

Each

4.20

W4739

Drain sponge

Each

.85

DMA, 919-857-4021

Attention: Durable Medical Equipment (DME) Providers

Coverage of Blood Glucose Monitors with Special Features

Effective with date of service January 1, 2000, blood glucose monitors with
special features (e.g. voice synthesizers, automatic timers, etc.), are being
added to the Capped Rental category of the DME Fee Schedule. The code, maximum
reimbursement rates, and lifetime expectancy are as follows:

Prior approval is required. Medical necessity must be documented on the Certificate
of Medical Necessity and Prior Approval form. All of the following coverage
criteria must be met:

The patient has a diagnosis of insulin-dependent diabetes, non-insulin
dependent diabetes, or gestational diabetes (ICD-9CM codes 250.0-250.93 or
648.8) which is being treated by a physician;

The glucose monitor and related accessories and supplies have been ordered
by the physician who is treating the patientís diabetes;

The patient (or the patientís caregiver) has successfully completed training
or is scheduled to begin training in the use of the monitor, test strips,
and lancets;

The patient (or the patientís caregiver) is capable of using the test results
to assure the patientís appropriate glycemic control;

The device is designed for home use;

The patientís physician certifies that the patient has a severe visual
impairment and documents the patientís best corrected visual acuity. A severe
visual impairment is defined as a best corrected visual acuity of 20/200 or
worse.

DMA, 919-857-4020

Attention: All Carolina ACCESS Providers

Changes Made within Your Practice

Carolina ACCESS (CA) primary care providers (PCPs) must communicate all pertinent
changes made within the practice to the local Managed Care Representative. Changes
may involve hospital admitting privileges, the CA contact person for the office,
new office hours, new providers added to the practice, etc. The Managed Care
Representative will notify the DMA Managed Care Section and the change will
be made to the CA Application and Agreement on file. If you need to know your
Managed Care Representativeís name or phone number, please call the DMA Managed
Care Section at 919-857-4022.

DMA Managed Care Section 919- 857-4022

Attention: All Providers

Corrected 1099 Requests - Action Required by March
15, 2000

Providers receiving Medicaid payments of more than $600 annually will receive
a 1099 MISC tax form from Electronic Data Systems Corporation (EDS). This 1099
MISC tax form is generated as required by IRS guidelines. It will be mailed
to each provider no later than January 31, 2000. The 1099 MISC tax form will
reflect the tax information on file with Medicaid as of the last Medicaid Checkwrite
cycle date, December 23, 1999. If the tax name or tax identification number
on the annual 1099 MISC you receive is incorrect, a correction to the
1099 MISC can be requested. Requesting a correction is in your best interest.
Correction ensures accurate tax information is on file with Medicaid and sent
to the IRS annually. When the IRS receives incorrect information on your 1099
MISC it may require backup withholding in the amount of 31 percent of future
Medicaid payments. The IRS could require EDS to initiate and continue this
withholding to obtain correct tax data.

A correction to the original 1099 MISC must be submitted by March 15, 2000
and must be accompanied by the following documentation:

A copy of original 1099 MISC

A completed Special W-9 (included in this bulletin) clearly indicating
the correct tax identification number and tax name or a completed IRS W-9
form (ensure all fields are completed as required)

A signed and dated Special W-9 or IRS W-9 certifying that the tax information
provided is correct

Upon receipt of the fax or mailed correction request, tax information on file
with Medicaid will be updated according to the Special W-9 or IRS W-9. Tax information
updates can be verified by checking the last page of each Medicaid Remittance
and Status Report (RA) which reflects both provider tax name and tax identification
number on file. Additionally, a copy of the corrected 1099 will be generated
and mailed for your record retention. All corrected 1099 requests will be summarized
and reported to the IRS as required.

EDS, 1-800-688-6696 or 919-851-8888

Special W-9

Complete all four parts of the Special
W-9 Form and return to EDS. Incomplete forms will be returned to
you for proper completion.

Attention: Inpatient Psychiatric Hospital Providers

Update On Continued Stay Review

First Mental Health (FMH) performs utilization review of inpatient services
in all psychiatric hospitals and in specified general hospitals for individuals
under the age of 21, and through 64 years of age in psychiatric units of specified
general hospitals. This includes pre-admission and concurrent review. As a result
of this review, either additional days are certified because the information
is complete and the client meets criteria for continued stay, or the case has
to be referred for a physician consultation due to insufficient information
to justify the stay. At this time, FMH arranges a "peer to peer" telephone conference
between the consulting physician and the attending physician to discuss the
case and obtain more information. Failure of the clientís physician to keep
the appointment for the "peer to peer" consultation will result in denial of
continued stay for the client. This denial is an administrative or technical
denial. There is no appeal process for the client.

The Division of Medical Assistance recommends all participants follow through
in the "peer to peer" consultation. If a conference is scheduled and it is subsequently
decided that the conference is not needed, please call and cancel.

In January 2000, FMH will send a letter to hospital administrators in facilities
that have administrative denials. This letter will serve as a reminder to comply
with procedures involving the "peer to peer" consultation. In subsequent months
a letter will be sent to facilities whose physicians continue to cause administrative
or technical denials.

If there are questions, contact Carolyn Wiser, RN or Callie Silver, RN, at
919-857-4025.

Attention: All Prescribers

Conversion From UPIN To DEA
Number

In order to identify prescribers better in our claims processing system, we
are going to move from using the UPIN on pharmacy claims to using the DEA number.
The target date for the implementation of this change is April 1, 2000.

This change in information submitted on the pharmacy claims will facilitate
the work of the Third Party Recovery Section, the Drug Utilization Review Program,
and the Pharmacy Review Section.

If you receive inquiries from EDS or DMA to verify your provider numbers and
DEA numbers, please respond immediately. It is critical that these numbers match
in our system and that our provider files are correct.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Third Party Billing

The Third Party Recovery Section within the Division of Medical Assistance
frequently receives telephone calls from Medicaid recipients concerning providers
who bill them for services, which have already been filed with Medicaid and
other health insurance plans.

When a provider bills the Medicaid program and indicates an insurance payment
on the claim form and/or attaches an insurance EOB, the third party payment
is applied toward the Medicaid allowable for the claim. If the third party payment
is equal to or greater than the Medicaid allowed amount, Medicaid will pay $0.00
on that claim. If the third party payment is less than the Medicaid allowed
amount, Medicaid will pay the difference between the third party payment and
the Medicaid allowed amount. The provider must not bill the Medicaid recipient
(or any financially responsible relative or representative of that recipient)
for any difference above the Medicaid payment or other third party payment.

If the provider is notified of the availability of other insurance coverage
after Medicaid has made payment, the provider must file the charges with the
third party payer. Upon receipt of the insurance payment, the provider must
refund Medicaid the lesser of the two payments.

When the recipientís private health insurance company pays the recipient directly,
the provider may bill the recipient for the amount of the insurance payment.
If the amount is unknown, the provider may bill the total charges until the
payment amount is known. When the provider has determined the amount of the
insurance payment, the provider may then file the claim with Medicaid, indicating
the insurance payment amount in the appropriate block on the claim form. Medicaid
will process the claim for payment, less the insurance payment. The provider
may continue to bill the recipient up to the amount of the insurance payment
until full insurance payment is received.

Third Party Recovery Section, DMA, 919-733-6294

Attention: Hospital Providers

Ancillary Services Paid without Prior Authorization

The Carolina ACCESS Emergency Room Reimbursement Policy includes payment of
the following ancillary services without prior authorization from the primary
care provider:

EDS is offering individual provider visits for Certified Registered Nurse Anesthetists
(CRNA) and Anesthesiologist providers. Please complete and return the CRNA
& Anesthesiologist Provider Visit Request Form. An EDS Provider Representative
will contact you to schedule a visit and discuss the type of issues to be addressed.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Health Check Providers

Health Check Seminar

Health Check seminars will be held in March 2000. The February Medicaid Bulletin
will have the registration form and a list of site locations for the seminars.
Please fill out the form Issues
you would like adressed at the Health Check Seminar and return to the following
address:

Provider Services
EDS
P.O. Box 300009
Raleigh, NC 27622

EDS, 1-800-688-6696 or 919-851-8888

Attention: Home Health Providers

Home Health Seminar Schedule

Seminars for Home Health providers will be held in February 2000. Each provider
is encouraged to send new and/or appropriate administrative, clinical, and clerical
personnel. The primary topic is the October 1999 Special Bulletin regarding
new Home Health billing instructions effective with February 1, 2000 date of
service. The agenda also includes Program Integrity issues, commonly identified
Home Health program errors, and a review of procedures for filing home health
claims, common billing errors, and follow-up procedures.

Due to limited seating, pre-registration is required. Providers not registered
are welcome to attend when reserved space is adequate to accommodate. Please
select the most convenient site and return the completed Home
Health Provider Seminar Registration Form to EDS as soon as possible. Seminars
begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive
by 9:45 a.m. to complete registration.
Note: Providers are requested to bring their most updated Community Care
Manual. Additional manuals will be available for purchase at $20.00.
Directions

Directions to the Home Health Seminars

WILMINGTON, NORTH CAROLINA

I-40 East into Wilmington to Highway 17 - just off of I-40. Turn left onto
Market Street and the Four Points Sheraton is located on the left.

WILLIAMSTON, NORTH CAROLINA

MARTIN COMMUNITY COLLEGE

Thursday, February 10, 2000

Highway 64 into Williamston. The college is approximately 1-2 miles west
of Williamston. The Auditorium is located in Building 2.

HICKORY, NORTH CAROLINA

CATAWBA VALLEY TECHNICAL COLLEGE

Wednesday, February 16, 2000

Take I-40 to exit 125 and go approximately ½ mile to Highway 70.
Head East on Highway 70 and the college is approximately 1.5 miles on the right.
Ample parking is available. Entrance to Auditorium is between the Student Services
and the Maintenance Center. Follow sidewalk (towards Satellite Dish) and turn
right to Auditorium Entrance.

SALISBURY, NORTH CAROLINA

HOLIDAY INN CONFERENCE CENTER

Monday, February 21, 2000

Take I-85 to exit 75 and go approximately ½ mile. The Holiday Inn
is located on the right.

RALEIGH, NORTH CAROLINA

WAKEMED MEI CONFERENCE CENTER

Monday, February 21, 2000

Directions to the Parking Lot:

Take the I-440 Raleigh Beltline to New Bern Avenue, Exit 13A (New Bern Avenue,
Downtown). Go toward WakeMed. Turn left at Sunnybrook road and park at the East
Square Medical Plaza which is a short walk to the conference facility. Parking
is not allowed in the parking lot in front of the Conference Center. Vehicles
will be towed if not parked in the East Square Medical Plaza parking lot located
at 23 Sunnybrook Road.

Directions to the Conference Center from Parking Lot:

Cross the street and ascend steps from sidewalk up to Wake County Health
Department. Cross Health Department parking lot and ascend steps (with a blue
handrail) to MEI Conference Center. Entrance doors are on the left.

Checkwrite Schedule

January 12, 2000

February 8, 2000

March 7, 2000

January 19, 2000

February 15, 2000

March 14, 2000

January 27, 2000

February 24, 2000

March 21, 2000

March 30, 2000

Electronic Cut-Off Schedule

January 7, 2000

February 4, 2000

March 3, 2000

January 14, 2000

February 11, 2000

March 10, 2000

January 21, 2000

February 18, 2000

March 17, 2000

March 24, 2000

Electronic claims must be transmitted and completed by 5:00 p.m. on the
cut-off date to be included in the next checkwrite. Any claims transmitted after
5:00 p.m. will be processed on the second checkwrite following the transmission
date.